• Brian W Rotenberg, Jenna Theriault, and Sophie Gottesman.
• Department of Otolaryngology-Head and Neck Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
• Laryngoscope. 2014 Sep 1;124 Suppl 4:S1-9.

Objectives/HypothesisHealthcare remunerating agencies in North America require patients with obstructive sleep apnea (OSA) to undergo a continuous positive airway pressure (CPAP) trial before funding surgical therapy. The adherence rate of CPAP is problematic. This study's objective was to determine the proportion of surgically favorable patients who failed CPAP who subsequently benefitted from surgical therapy, and to explore consideration of surgical therapy as first-line treatment in this specific OSA subpopulation.Study DesignThis was a prospective cohort study.MethodsPatients with moderate-severe OSA who had failed a minimum 6-month trial of CPAP were recruited. All had optimal anatomy for surgery and underwent tonsillectomy with palatoplasty ± septoplasty. Outcome measures included apnea-hypopnea index (AHI), Epworth Sleepiness Scale (ESS), and Sleep Apnea Quality of Life Index (SAQLI-E), and blood pressure. Patients were followed for 1 year.ResultsBy AHI measurement, 85.7% of patients in the entire cohort were successfully treated by surgery. ESS while on CPAP was 13.7 ± 2.9, improving to 4.1 ± 2.5 after surgery. SAQLI-E scores on CPAP were 25.7 ± 5.8, improving to 10.2 ± 3.2 after surgery. Blood pressure remained elevated during CPAP but normalized after surgery. All changes were significant at P < .001.ConclusionsSurgical intervention improved OSA severity as measured by the ESS, SAQLI-E, and blood pressure. These measures had not improved on CPAP. AHI improved as well. Our results suggest that certain patients with OSA may be managed more effectively with surgery than CPAP, without confounding issues of treatment adherence and with only minor surgical risk.Level Of Evidence2 Laryngoscope 124:S1-S9, 2014.© 2014 The American Laryngological, Rhinological and Otological Society, Inc.

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